Patients with Degenerative Cervical Myelopathy Exhibit Neurophysiological Improvement Upon Extension and Flexion: a Retrospective Cohort Study with a Minimum 1-year Follow-up

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2022 Mar 24

PMID 35321685

Authors

Zhengran Yu

Jiacheng Chen

Xing Cheng

Dingxiang Xie

Yuguang Chen

Xuenong Zou

Xinsheng Peng

Affiliations

Soon will be listed here.

Abstract

Background: Cervical extension and flexion are presumably harmful to patients with degenerative cervical myelopathy (DCM) because they worsen medullary compression visible on dynamic magnetic resonance imaging (MRI). Dynamic somatosensory evoked potentials (SSEPs) are an objective tool to measure the electrophysiological function of the spinal cord at different neck positions. In contrast to previous hypotheses, a considerable proportion of patients with DCM present improved SSEPs upon extension and flexion compared to a neutral position.

Methods: Patients with DCM who underwent preoperative dynamic SSEP examinations and subsequent decompression surgeries between 2015 and 2019 were retrospectively evaluated. We compared extension and flexion SSEPs with neutral SSEPs in each patient and classified them into extension-improved (EI) or extension-nonimproved (EN) and flexion-improved (FI) or flexion-nonimproved (FN) groups. Preoperative clinical evaluations, decompression surgical methods and one-year follow-up clinical data were recorded. Cervical spondylolisthesis and cervical alignment types were evaluated on plain cervical lateral radiographs. The number of stenotic segments, Mühle stenosis grade and disc degeneration stage of the most severe segment, and presence of ligamentum flavum hypertrophy and intramedullary T2 weighted imaging (T2WI) hyperintensity were evaluated on lateral and axial MRI. Data were compared between the EN and EN groups or FI and FN groups with T-tests, chi-square tests or Kruskal-Wallis tests. Prediction criteria were determined with logistic regression analyses.

Results: Forty-nine patients were included, and 9 (18.4%) and 11 (22.4%) showed improved extension and flexion SSEPs compared to their own neutral SSEPs, respectively. Interestingly, EI or FI patients had significantly better one-year postoperative mJOA recoveries than EN or FN patients (T-test, P < 0.001). Moreover, the disease duration (T-test, P = 0.024), involved segment number (Kruskal-Wallis test, P < 0.001), and cervical alignment type (chi-square test, P = 0.005) varied significantly between the EI and EN groups. The FI group presented a significantly higher Mühle stenosis grade than the FN group (Kruskal-Wallis test, P = 0.038). Furthermore, ≤ 2 involved segments and straight or sigmoid cervical alignment were significant criteria predicting improved extension SSEPs (probability: 85.7%), while Mühle stenosis Grade 3 and disease duration ≤6 months were significant criteria predicting improved flexion SSEPs (probability: 85.7%).

Conclusions: Our findings provide evidence for neurophysiological improvement in patients with DCM at extension and flexion and its significance in predicting prognoses. Moreover, certain clinical and radiographic criteria may help predict neurophysiological improvement upon extension or flexion.

Trial Registration: " [2020]151 ". Retrospectively registered on April 30, 2020.

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References

Tamai K, Grisdela Jr P, Romanu J, Paholpak P, Buser Z, Wang J . Kinematic characteristics of patients with cervical imbalance: a weight-bearing dynamic MRI study. Eur Spine J. 2019; 28(5):1200-1208. DOI: 10.1007/s00586-018-05874-2. View

Park M, Moon S, Oh J, Lee H, Riew K . Natural History of Cervical Degenerative Spondylolisthesis. Spine (Phila Pa 1976). 2018; 44(1):E7-E12. DOI: 10.1097/BRS.0000000000002764. View

Ohara A, Miyamoto K, Naganawa T, Matsumoto K, Shimizu K . Reliabilities of and correlations among five standard methods of assessing the sagittal alignment of the cervical spine. Spine (Phila Pa 1976). 2006; 31(22):2585-91. DOI: 10.1097/01.brs.0000240656.79060.18. View

Chen C, Hsu H, Niu C, Chen T, Chen M, Tseng Y . Cervical degenerative disease at flexion-extension MR imaging: prediction criteria. Radiology. 2003; 227(1):136-42. DOI: 10.1148/radiol.2271020116. View

Hattou L, Morandi X, Reste P, Guillin R, Riffaud L, Henaux P . Dynamic cervical myelopathy in young adults. Eur Spine J. 2014; 23(7):1515-22. DOI: 10.1007/s00586-014-3321-z. View

Milligan J, Ryan K, Fehlings M, Bauman C . Degenerative cervical myelopathy: Diagnosis and management in primary care. Can Fam Physician. 2019; 65(9):619-624. PMC: 6741789. View

Muhle C, Metzner J, Weinert D, Falliner A, Brinkmann G, Mehdorn M . Classification system based on kinematic MR imaging in cervical spondylitic myelopathy. AJNR Am J Neuroradiol. 1998; 19(9):1763-71. PMC: 8337474. View

Morishita Y, Maeda T, Ueta T, Naito M, Shiba K . Dynamic somatosensory evoked potentials to determine electrophysiological effects on the spinal cord during cervical spine extension: clinical article. J Neurosurg Spine. 2013; 19(3):288-92. DOI: 10.3171/2013.5.SPINE12933. View

Montano N, Ricciardi L, Olivi A . Comparison of Anterior Cervical Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis of Clinical and Radiological Outcomes. World Neurosurg. 2019; 130:530-536.e2. DOI: 10.1016/j.wneu.2019.06.144. View

10.

Muhle C, Wiskirchen J, Weinert D, Falliner A, Wesner F, Brinkmann G . Biomechanical aspects of the subarachnoid space and cervical cord in healthy individuals examined with kinematic magnetic resonance imaging. Spine (Phila Pa 1976). 1998; 23(5):556-67. DOI: 10.1097/00007632-199803010-00008. View

11.

Hayashi T, Wang J, Suzuki A, Takahashi S, Scott T, Phan K . Risk factors for missed dynamic canal stenosis in the cervical spine. Spine (Phila Pa 1976). 2014; 39(10):812-9. DOI: 10.1097/BRS.0000000000000289. View

12.

Nuwer M, AMINOFF M, Desmedt J, EISEN A, Goodin D, Matsuoka S . IFCN recommended standards for short latency somatosensory evoked potentials. Report of an IFCN committee. International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol. 1994; 91(1):6-11. DOI: 10.1016/0013-4694(94)90012-4. View

13.

Suzuki A, Daubs M, Inoue H, Hayashi T, Aghdasi B, Montgomery S . Prevalence and motion characteristics of degenerative cervical spondylolisthesis in the symptomatic adult. Spine (Phila Pa 1976). 2013; 38(17):E1115-20. DOI: 10.1097/BRS.0b013e31829b1487. View

14.

Ordway N, Seymour R, Donelson R, Hojnowski L, Edwards W . Cervical flexion, extension, protrusion, and retraction. A radiographic segmental analysis. Spine (Phila Pa 1976). 1999; 24(3):240-7. DOI: 10.1097/00007632-199902010-00008. View

15.

Zhang L, Zeitoun D, Rangel A, Lazennec J, Catonne Y, Pascal-Moussellard H . Preoperative evaluation of the cervical spondylotic myelopathy with flexion-extension magnetic resonance imaging: about a prospective study of fifty patients. Spine (Phila Pa 1976). 2011; 36(17):E1134-9. DOI: 10.1097/BRS.0b013e3181f822c7. View

16.

Li Z, Xue Y, He D, Tang Y, Ding H, Wang Y . Extensive laminectomy for multilevel cervical stenosis with ligamentum flavum hypertrophy: more than 10 years follow-up. Eur Spine J. 2014; 24(8):1605-12. DOI: 10.1007/s00586-014-3459-8. View

17.

Benzel E, Lancon J, Kesterson L, Hadden T . Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord. 1991; 4(3):286-95. DOI: 10.1097/00002517-199109000-00005. View

18.

de Arruda Serra Gaspar M, Cliquet Jr A, Fernandes Lima V, de Abreu D . Relationship between median nerve somatosensory evoked potentials and spinal cord injury levels in patients with quadriplegia. Spinal Cord. 2009; 47(5):372-8. DOI: 10.1038/sc.2008.147. View

19.

Tetreault L, Kopjar B, Vaccaro A, Yoon S, Arnold P, Massicotte E . A clinical prediction model to determine outcomes in patients with cervical spondylotic myelopathy undergoing surgical treatment: data from the prospective, multi-center AOSpine North America study. J Bone Joint Surg Am. 2013; 95(18):1659-66. DOI: 10.2106/JBJS.L.01323. View

20.

Liu S, Lafage R, Smith J, Protopsaltis T, Lafage V, Challier V . Impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in cervical spondylotic myelopathy. J Neurosurg Spine. 2015; 23(6):690-700. DOI: 10.3171/2015.2.SPINE14414. View